Watanabe Yuichi
Institute of Developing Economies, Japan External Trade Organization (IDE-JETRO), 3-2-2 Wakaba, Mihama-ku, Chiba, Chiba Prefecture, 261-8545, Japan.
Health Econ Rev. 2024 Oct 10;14(1):86. doi: 10.1186/s13561-024-00557-9.
Many countries have sought to promote well-being for their entire populations through the implementation of universal health coverage (UHC). To identify the extent to which UHC has been attained, it is necessary to evaluate equity of access to use of needed care and the cost burden of health services for the country's entire population. This study considers income-related inequalities in health care utilization and spending in a long-term perspective for the case of the Republic of Korea.
Exploiting longitudinal data from a nationally representative health survey from 2008 to 2018, this study investigates how income-related inequalities in health care in Korea have varied over time and examines the extent to which need and non-need factors contribute those inequalities, using an in-depth decomposition analysis, allowing for heterogeneous responses across income groups.
The empirical results show that overall health care utilization is disproportionately concentrated among the poor over both the short and long run. Income-group differences and non-need determinants, such as marital status and private health insurance, make larger pro-poor contributions to inequality in inpatient care use, while chronic disease prevalence greatly pushes outpatient care utilization in a pro-poor direction. The results regarding inpatient care expenses indicate a similar pattern of pro-poor bias. Long-run inequality favors the better-off in terms of outpatient care expenses, where the contribution of income-group differences has the largest impact.
My findings suggest that it is important for health care policy in Korea to focus on improvements in the health status and well-being of low-income groups, as poor people are likely to be in poorer health. Non-need contributors could worsen pro-poor inequalities if the economic disparity across households were to increase due to the demographic transition. Higher spending on inpatient care may be a heavier financial burden for low-income people. Additional supportive measures should be provided to prevent them from suffering economic hardship. By contrast, people in high-income groups may spend most on costly services in outpatient care, including uninsured services, with the help of private health insurance. Nevertheless, the expansion of income disparity should be alleviated even from a health care policy perspective.
许多国家试图通过实施全民健康覆盖（UHC）来促进全体民众的福祉。为了确定全民健康覆盖的实现程度，有必要评估获得所需医疗服务的公平性以及该国全体民众的医疗服务成本负担。本研究从长期角度考虑韩国在医疗保健利用和支出方面与收入相关的不平等情况。
利用2008年至2018年全国代表性健康调查的纵向数据，本研究调查了韩国医疗保健方面与收入相关的不平等如何随时间变化，并使用深入分解分析方法，考虑不同收入群体的异质性反应，研究需求和非需求因素对这些不平等的影响程度。
实证结果表明，从短期和长期来看，总体医疗保健利用在穷人中分布不均。收入群体差异以及婚姻状况和私人医疗保险等非需求决定因素，对住院护理使用不平等的扶贫贡献更大，而慢性病患病率极大地推动了门诊护理利用向扶贫方向发展。住院护理费用的结果显示出类似的扶贫偏差模式。在门诊护理费用方面，长期不平等有利于富裕群体，其中收入群体差异的影响最大。
我的研究结果表明，韩国的医疗保健政策应注重改善低收入群体的健康状况和福祉，因为穷人可能健康状况较差。如果由于人口结构转变导致家庭间经济差距加大，非需求因素可能会加剧扶贫不平等。住院护理费用增加可能给低收入人群带来更沉重的经济负担。应提供额外的支持措施，以防止他们遭受经济困难。相比之下，高收入群体的人可能在门诊护理的昂贵服务（包括未参保服务）上花费最多，这得益于私人医疗保险。然而，即使从医疗保健政策角度来看，也应缓解收入差距扩大的问题。
